EPIFFANY affects these improvements by making small changes to the way individuals are educated, receive feedback; work as a team; and use clinical decision support technologies for work or study, much like the principles used by Team Sky to win the Tour De France.
The approach creates a safe learning environment, using simulations including real outpatients for junior doctor-patient encounters complemented with principles of human factors and educational theory like self-regulated learning. EPIFFANY is effective at improving prescribing competence for those taking part, and impacting positively on junior doctors’ confidence, well-being and attitude to work. It delivers improvements through high, ecologically valid simulations, face-to-face teaching and feedback to realise the large gains in performance made by individuals. Clinical decision support is also made available on mobile devices.
EPIFFANY was developed by The University of Leicester and initially piloted in 2013 at Leicester General Hospital’s, John Walls Renal Unit, University Hospitals Leicester NHS Trust. East Midlands Academic Health Science Network, Health Education England East Midlands and Pfizer assisted with an additional rollout at Pilgrim Hospital Boston, United Lincolnshire Hospitals NHS Trust, in 2015-2016 for all junior doctors working in general surgery and orthopaedics.
EPIFFANY is in the process of being evaluated at 3 further East Midlands trusts for sustainability to enable wider adoption. It is also being evaluated overseas in New Zealand at Waitemata and Canterbury District Health Board hospitals and has recently spread to Wigan, Great Manchester.
Example impacts so far
• Increased prescribing performance of junior doctors by over 50% across a 4 month rotation at Leicester General Hospital’s, John Walls Renal Unit
• Increased prescribing performance of junior doctors by over 50% across a 4 month rotation in Pilgrim Hospital Boston’s General Surgery specialty
• Analysis showed a 60% increase in prescribing performance of junior doctors across a 4 month rotation in Pilgrim Hospital Boston’s Orthopaedic speciality
• Reduced prescribing errors of junior doctors at in Leicester General Hospital’s, John Walls Renal Unit and Pilgrim Hospital Boston’s General Surgery and Orthopaedics’ across all severity grades
• Improved satisfaction with education and training among junior and trust grade doctors
• Increased junior doctors’ wellbeing and self-confidence so they consider remaining in the East Midlands to continue and develop themselves personally and professionally
• Promoting pharmacists as educators by incorporating pharmacists in the team, and empowering them to give individualised feedback
• Cost avoidance in medication errors as well as potential bed days and litigation
• Commission on Education and Training for Patient Safety report includes the EPIFFANY project: https://hee.nhs.uk/sites/default/files/documents/FULLreportmediumresforweb.pdf
With funding and support from East Midlands AHSN, Health Education England East Midlands and Pfizer a toolkit to facilitate spread and sustainability of EPIFFANY is currently being produced and will be evaluated to inform the best approach to scale-ability.